Concerns for Equity of Maternity Services in Rural Areas

Maternity services have come under the spotlight with the announcement that an anonymous group of midwives has sent a complaint alleging that midwifery is at a crisis point to the Health and Disability Commissioner.

The letter is now being handled by the Ministry of Health (as confirmed to the Otago Daily Times newspaper). While the contents of the 33-page letter are not known to the public, Rural Women New Zealand (RWNZ) has concerns in two areas.

This letter comes at a time when smaller maternity units are being threatened by closure, meaning that women living in rural areas will no longer have a choice in where they give birth and will have to go to larger urban areas away from home and family.

RWNZ can name maternity hospitals in Te Anau, Lumsden and Tutatapere in the South Island and Te Kuiti in the North that are currently under threat of closure. Government and DHB’s will claim that the services are being under-used, but the reality for newly pregnant women when they must make a choice about where they will give birth, is that the uncertainty of a smaller hospital’s future leaves them with no choice than to go to an urban area.

Rural women are already at a disadvantage with their maternity care. During the first three months of pregnancy, the midwife and the mother must come to an agreement over the number of visits made at home once the baby has been born. It is appreciated that distance and time for midwives to travel to rural areas is an issue and that the seven, or more home visits are unlikely to happen with the current level of recompense that midwives receive. Most will agree to one visit with the expectation that the mother will then be able to travel to a clinic for the aftercare that they are entitled to.

In most cases, the arrangement works unless the new mother has had a caesarean birth and is unable to drive for six weeks. Not only is she deprived of essential aftercare, in some cases they can be isolated from other support services and family. There may be further issues when the new mother is a migrant worker, or English is a second language, or where there is a variable income. The demands of seasonal farm work will often play their part too, and it is not always possible for a farmer to stop work over the six week period of midwife aftercare to transport the new mother and baby to appointments.

Government and DHB’s need to accept responsibility for optimum care for new mothers and babies at a time in life when the need for guidance and advice is crucial. The early days of a baby’s life and the ability of the mother to adapt and cope with new demands are crucial for the future health of the baby. Care delivered at this early stage is an investment in the lifetime health of a child.

Whatever the outcome from the letter the midwives have sent, it will be founded on genuine deep concern for the health of mother and babies, and Rural Women New Zealand is hopeful that their concerns will be considered with that knowledge in mind.

Rural Women New Zealand believes that all women regardless of their geographical location deserve equity of maternity services.

Note: Midwives letter referenced in Otago Daily Times, published 29 May 2017.